Control and disordered eating in type 1 diabetes

Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain: 52-week data from the PREDICTIVE study in a cohort of French patients with type 1 or type 2 diabetes

AIM

PREDICTIVE (an ongoing multinational observational study) provides an opportunity to explore the impact of insulin detemir use in routine clinical practice. Here, we report on long-term (52-week) data from a French cohort of patients (n=1772), comprising 643 with type 1 diabetes and 1129 with type 2 diabetes.

METHODS

Patients were prescribed insulin detemir at their physician's discretion and assessed at various visits (baseline, 12 weeks, 26 weeks and 52 weeks). The primary endpoint was the frequency of serious adverse drug reactions, including major hypoglycaemia. Secondary endpoints included minor and nocturnal hypoglycaemia, glycaemic control (HbA(1c), fasting blood glucose and variability of fasting blood glucose) and weight change.

RESULTS

The incidence of serious adverse drug reactions was low throughout the study, seen in 10 patients with type 1 diabetes (14 events, 1.6%) and seven with type 2 diabetes (seven events, 0.6%). In both type 1 and type 2 diabetes cohorts, the overall minor and nocturnal hypoglycaemic events were reduced from baseline (P<0.001), with no clinically significant changes in weight from baseline to endpoint. After 52 weeks of treatment with insulin detemir, glycaemic control improved, with reductions in: HbA(1c), by -0.6% and -0.8% in type 1 and type 2 diabetes patients, respectively; fasting blood glucose, by -1.4mmol/L and -1.9mmol/L respectively; and FBG variability, by -0.8mmol/L and -0.3mmol/L, respectively (P<0.0001 for all).

CONCLUSION

Patients treated with insulin detemir in a clinical healthcare setting improved their glycaemic control with no increases in hypoglycaemia, adverse events or weight compared with baseline.

Insulin aspart: rapid control for postmeal glucose excursions

Insulin aspart is a rapid-acting insulin analog that can be used to control prandial glucose levels as part of basal-bolus therapy, in continuous subcutaneous insulin infusion or in combination with oral antidiabetic drugs. Compared with exogenous human soluble insulin, insulin aspart has a faster onset of action, a higher peak concentration and a shorter duration of action, and is therefore more comparable to the physiological prandial insulin response. Randomized clinical trials have shown efficacy and safety advantages with insulin aspart over human soluble insulin, in particular, improved postprandial glucose control and lower rates of hypoglycemia. Currently, insulin aspart has been approved for use not only in adults and children with diabetes mellitus, but also for pregnant women with diabetes, including those with gestational diabetes.